Provider Demographics
NPI:1881371631
Name:KAMMERER, STACI LYNN (RN)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:LYNN
Last Name:KAMMERER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:LYNN
Other - Last Name:STIEBEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1414 PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-4142
Mailing Address - Country:US
Mailing Address - Phone:620-960-1526
Mailing Address - Fax:650-618-1445
Practice Address - Street 1:1414 PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-4142
Practice Address - Country:US
Practice Address - Phone:650-376-6010
Practice Address - Fax:650-618-1445
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-93729-081163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse